Now What? Treatment Options for Alzheimer's Disease

There are more than 5.4 million Americans living with Alzheimer's disease, a form of dementia, and it is the sixth leading cause of death in the United States. According to the Alzheimer's Association, people diagnosed with Alzheimer's live an average of eight years after being diagnosed, though some survive up to 20 years depending on their age and other health conditions. There are treatments to slow the progressive symptoms and improve quality of life -- which is important for the person with Alzheimer's as well as their loved ones and caregivers -- but there is no cure for Alzheimer's disease.

Drug Treatment Options

The Food and Drug Administration has approved two types of medications -- cholinesterase inhibitors and memantine -- to treat symptoms such as memory loss, confusion, and problems with thinking and reasoning.

"While current medications cannot stop the damage Alzheimer's causes to brain cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain's nerve cells," states the Alzheimer's Association. "Doctors sometimes prescribe both types of medications together. Some doctors also prescribe high doses of vitamin E for cognitive changes of Alzheimer's disease."

"One of the things that is very important is to identify the signs and symptoms of Alzheimer's as early as possible," said Dr. Mary Sano, psychiatry director of the Alzheimer's Disease Research Medicine at the Mount Sinai School of Medicine. "Alzheimer's disease is really devastating and something that everyone worries about."

The first signs can come in a variety of forms -- memory problems, difficulties in a job, complaint from a loved one about cognitive abilities, and much more -- and then there should be a professional evaluation. "The cognitive testing can provide a very early detection," she said. "There are many research studies available."

Clinical Trials

There is ongoing to research to find medications that will not just treat the symptoms of Alzheimer's disease, but hopefully stop or slow the progress of it. In order to develop new treatments, volunteers are needed for clinical trials.

"Volunteering to participate in a study is one of the greatest ways someone can help move Alzheimer's research forward," states Bill Thies, Ph.D., chief medical and scientific officer of the Alzheimer's Association, on the association's website. "Second, we need a significant increase in federal research funding. Investing in research now will cost our nation far less than the cost of care for the rising number of Americans who will be affected by Alzheimer's in coming decades."

1. "First, talk to a doctor, who may know about local or specific research studies that may be of benefit," he said. "National Institutes of Health-supported Alzheimer's Disease Centers or specialized memory or neurological clinics near the patient's location may also be conducting trials." To that end, the Alzheimer's Disease Education and Referral Center of the National Institutes of Health has a detailed repository of current trials.

2. The Alzheimer's Association is another good resource for trial treatments.

3. Another online venue is ClinicalTrials.gov, also part of the National Institutes of Health, which lists clinical trials in a variety of ways.

"There are currently over 50 NIH-sponsored trials relating to Alzheimer's disease," said Dr. Potts. "These range from developing new strategies and biomarkers for early detection of Alzheimer's pathology in pre-symptomatic individuals, to trials looking into the genetics of the disease in affected families, to trials testing agents for therapeutic benefit."

He cites one that has been in the news recently -- testing passive immunization with gamma globulin (IvIg) to reduce the brain build up of amyloid, one of the proteins implicated as a cause of Alzheimer's disease. "Another is looking at whether the application of a nerve growth factor (which stimulates growth and repair of neurons) to the brain will be an effective treatment," he said. "Certain treatments for diabetes are being tested in Alzheimer's disease, as there is thought to be a link between the brain's ability to utilize glucose and the disease. There are also trials testing hormone replacement therapy, drug treatments for high cholesterol, seizure medications, and experimental agents which block the enzymes responsible for the formation of toxic build up of amyloid protein in the brain, among others."

When it comes to searching the above sites for tests, Dr. Potts said that people can rest assured "that trials listed on these sites are rigorously evaluated and monitored for safety and efficacy."

Are these trials safe for just everyone? One's own doctor should be consulted first and Dr. Potts said there are some questions to ask.

"The most important would be whether or not one's medical condition, medications, and medical risk factors would make one an acceptable trial candidate," he said. "Safety is paramount. I also would like to emphasize the importance of lifestyle changes in prevention, such as exercise and the Mediterranean diet."

Dr. Sano also recommends also reviewing one's family history and pointed out that just because close family members have gotten Alzheimer's disease does not mean that you necessarily will also get it.

"We are just beginning clinical trials for people who want to prevent the disease," said Dr. Sano. "It's really at the cutting edge. When someone participates in research, it allows them to find out what their potential risk is for the future."

Non-Drug Treatment Options

Another aspect of Alzheimer's disease is the change in behaviors, which can be exacerbated by medication, environmental influences, and other medical conditions. These behavioral changes may be expressed in irritability and depression and then progress to anger, outbursts and even hallucinations. Some non-drug treatments to these behavioral changes involve figuring out what is triggering the person to act out; perhaps they are experiencing vision problems but cannot communicate this or they are confused in a new environment such as a hospital or nursing home. Weekly Dementia Care Tips, published free for the public by Homewatch CareGivers, provides ongoing tips and ideas related to dealing with symptoms of dementia.

"Even though the chief cause of behavioral symptoms is the effect of Alzheimer's disease on the brain, an examination may reveal other treatable conditions that are contributing to the behavior," notes the Alzheimer's Association.

Since people with Alzheimer's tend to develop sleep difficulty, there are recommended non-drug and drug treatments to deal with this because fatigue can worsen other symptoms and also lead to a lack of sleep for the in home caregiver.

"As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer's on the brain," the Alzheimer's Association states on their website. "When managing sleep changes, non-drug coping strategies should always be tried first."

Among the non-drug treatments they suggest are maintaining a schedule for meals, naps, and bedtime, providing morning sunlight exposure, getting daily exercise earlier in the day, avoiding alcohol, caffeine, and nicotine, avoiding giving certain medications right before going to bed, and provide nightlights in a room that is a comfortable temperature.

The Alzheimer's Association website also offers a look at alternative treatments, and expresses their concerns about the scientific proof and possible side effects of these herbal remedies and dietary supplements. "Claims about the safety and effectiveness of these products, however, are based largely on testimonials, tradition and a rather small body of scientific research," they note.